HomeMy WebLinkAbout0016 DARTMOUTH STREET - Health 16 Dartmouth-Street, Sewer Acct #2610
r Hyannis
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March 04, 2009
NOTIFICATION OF ASBESTOS ABATEMENT
ATTENTION: Barnstable Health Department
200 Main Street
Hyannis,MA 02601
Northeast Remediation will be conducting an asbestos abatement project at the following
location. Please note the site and dates listed below,with the latter being subject to changes. Do
not hesitate to contact our office for more detailed scheduling information at 617-389-9188.
BUILDING LOCATION: House Project
16 Dartmouth Street
Hyannis,MA 02060
1't Floor—Kitchen Area
START DATE: 03/18/09
END DATE: 03/20/09
Asbestos signs will be clearly posted in all areas where work is being conducted. Please take the
necessary precautions in the event you are required to enter the building during an emergency.
If you have further questions with respect to this abatement project,please do not hesitate to
contact our office at any time at(617) 389-9188. Thank you very much for your attention
regarding this matter. i
Very truly yours,
NORTHEAST REMEDIATION
cn '
Wendy Ca-asCD ;=
Projects Coordinator rn
I
Corporate Headquarters New England Office,
462 Getty Avenue 25 Storey Avenue#256
Clifton,NJ 07011 Newburyport,MA 01950
Tel.617-389-9188 Fax 617-389-9198
Commonwealth of Massachusetts ■
100085227
:~ Decal Number
Asbestos Notification Form.ANF-001
Important:When filling out A. Asbestos Abatement Description
forms to the 1. a. Is this facility fee exempt city, town, district, municipal housing authority, owner-occupied
computer,use Y P ' tY, P 9 Y� P
only the tab key residence of four units or less? ❑✓ Yes ❑ No
to move your
cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number
use the return
key' 2. Facility Location:
HOUSE PROJECT 16 DARTMOUTH STREET W
a.Name of Facility b.Street Address
HYANNIS MA 02060 —��—�
c.City/Town d.State e.Zip Code f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1.All sections of this 1ST FLOOR KITCHEN
form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ❑✓ Yes ❑No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division
of Occupational NORTHEAST REMEDIATION 125 STOREY AVE
Safety(DOS) a.Name b.Address
notification requirements of 453 NEWBURYPORT, 1 01950 1 16173899188
CMR 6.12 c.City/Town d.Zip Code e.Telephone Number
AC000392 g. Contract Type: .❑✓I Written ❑Verbal
f.DOS License Number
PETER ZABITO JOWENR
h.Facility Contact Person i.Contact Person's Title
IEDWIN ALMONTE _ AS033135
6' a.Name of On-Site Supervisor/ oreman b.Supervisor/Foreman DOS Certification Number
IENVIRO SAFE �I ❑AA000131
7 1—___�. _ _
a.Name of Pro ect Monitor b.Pro ect Monitor DOS Certification Number
YEE CONSULTING GROUP I IAA000145
$' a.Name of Asbestos Analytical Lab b.Asbestos Anal tical Lab DOS Certification Number
�0 9 �03118/2009 03/20/2009
a.Project Start Date mm/dd/ b.End Date mm/dd/
�0 7AM-4PM N/A
N c.Work hours Mon-Fri. d.Work hours Sat-Sun. ,
=o 10. a. What type of project is this?
-o ❑ Demolition ❑ Renovation
❑ Repair ❑ Other, please specify: b.Describe
11. a. Check abatement procedures:
o ❑Glove bag ; Encapsulation
-o ✓❑ Enclosure ❑ Disposal only
_L ❑ Cleanup ❑ Other, specify:
❑Full containment b.Describe
-z
_Q 12. Is the job being conducted: �✓�' Indoors? ❑Outdoors?
■ anf001 ap.doc•10/02 Asbestos Notification Form•Page 1 of 3■
Commonwealth of Massachusetts ■
/00085227
Decal Number
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
/ encaosulated:
10 400
a.Total pipes or ducts(linear ) b.Totalother surfaces square
c.Boiler,breaching,duct,tank � � � �d.Insulating cement
surface coatings Lin.ft. SS ft. Lin.ft. Sq.ft.
e.Corrugated or layered paper l_.._.� f.Trowel/Sprayer coatings
pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft.
g.Spray-on fireproofing Lin.
Sq= h.Transite board,wall board Lin "q =
i.Cloths,woven fabrics L___ _.- j.Other,please specify: L
Lin S Lin.ft.
k.Thermal,solid core pipe LINOLEUM FL.
insulation Lin.ft. Sq.ft. I.Specify
14. Descrile the decontamination system(s)to be used:
2-CHAMBERED DECONTAMINATION FACILITY WITH WASH STATION
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
ACM WILL BE WET(HAND TO BAG)ACM WILL BE LABLED, PACKAGED&TRANSPORTED.
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
NIA i
a.Name of DEP Official b.Title
c.Date(mm/dd/y yy)of Authorization d.DEP Waiver#
NIA
e.Name of DOS Official f.DOS Official it e
i
g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver#
N
_0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? Yes 0 No
B. Facility Description
�N
=o 1. Current or prior use of facility: _..
HOUSE
_0 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes 0 No
PETER ZAMBITO 16 DARTMO ITH STREET
3' a.Facility Owner Name b.Address
HYANNIS, MA 102060 1914 403 6068
o c.City/Town d.Zip Code e.Telephone Number area code and extension)
emu. 4 PETER ZAMBITO 16 DARTMOUTH STREET
a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address
Z HYANNIS, MA 02060 914 403 6068
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
■ anf001 ap.doc•10/02 Asbestos Notification Form•Pa e 2 of 3 ■
l Commonwealth of Massachusetts.
100085227
Asbestos Notification Form ANF-001 Decal Number
B. Facility Description (cont.)
N/A _
5' a.Name of General Contractor b.Address
c.City/Town d.Zip Code e.Telephone Number area code( and extension)
f.Contractor's Worker's Comp.Insurer .Policy Number h.ExxpDate(mm/dd/yyy
6. What is the size of this facility?
a.Square Feet b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
NORTHEAST REMEDIATION 25 STOREY AVENUE#256
Note:Transfer a.Name of Transporter b.Address
Stations must INEWBURYPORT, MA 1 101950 (617)389-9188
comply with the c.City/Town d.Zip Code e.Telephone Number
Solid Waste
Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
Regulations 310
CMR 19.000 ISERVICES TRANSPORT GROUP 58 PYLES LANE
a.Name of Transporter _ b.Address
NEW CASTLE, DE �� 197201 (877)999-9559
c.City/Town d.Zip Code e.Tele hone Number
3. N/A
a.Refuse Transfer Station and Owner b.
b.Address
c.City/Town d.Zip Code e.Telephone Number
4. IMINERVA ENTERPRISES INC
a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name
9000 MINERVA ROAD WAYNESBURG
c Final Disposal Site Address d.Cit !Town
OH 44688 1
e.State f.Zip Code g.Telephone Number
=0
D. Certification
The undersigned hereby states, under the WENDY CARIAS UAL b r 1 C
�0 penalties of perjury,that he/she has read the a.Name b.Authorized Signature
0 Commonwealth of Massachusetts regulations 1PROJECT COORDINATO 03/04/2009
for the Removal, Containment or c.Position/Title d.Dat�mm/dd/yvvv)
7 Encapsulation of Asbestos,453 CMR 6.00 and (617) 389-9188 � NER
310 CMR 7.15,and that the information
contained in this notification is true and correct e.Telephone Number f.Representing
c) to the best of his/her knowledge and belief. 125 STOREY AVENUE#256
q Address
LL NEWBl RYPORT, MA� 01950
h.City/Town i.Zip Code
Z
anf001 ap.doc-10/02 Asbestos Notification Form-Page 3 of 3
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LOCATION �a S SEWAGE PERMIT NO.
VILLAGE
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INSTA LLER'S NAME i ADDRESS wvl Zff
JOHN A. AALTO .SrACKHOE SERV►rp
0alnut Strut
West Barnstable, Mass. O2Ftig
t U I L 0 E R OR OWNER
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DATE PERMIT ISSIJfED
DATE COMPLIANCE 15SUED ,:3 ' �
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF -HEALTH
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Allpfiration for Bhipoiial Works Tonotrurtion Virmit,
r •aApplication is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal-,
System at:
........... ........................................... . ....t
LocatiQn-Add ess oi Lot No.
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Ot;er Address
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Installer Address
Type,o ding Size Lot............................Sq. feet.
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No. of Bedroonis..',. ......................................Expansion Attic. ( Garbage Grinder (
Other—Type of Building ............................. No. of persons.__.__.__..._..__________.. Showers Cafeteria (
Otherfixturrs ........................................................................................................................................................
Design Flow............_ .......................gallons per person per day. 'Total daily flow---------- ..................gallons.
1:4 Septic Tank—Liquid capacity. ......gallons Length................ Width-____._____-____ Diameter................ Depth.._.__..__......
Disposal Trench—No..................... Width--_---------------- Total Length______.............. Total leaching area-------------------sq. f t.
Seepage Pit No.--______--_-_-__-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date.......................................
Test Pit No. I----------------minutes per inch Depth of Test Pit___.__._...._..._... Depth to ground water------------------------
Test Pit No. 2................minutes per inch Depth of Test Pit_.____......_.__._.. Depth to ground water....._____......._..___.
............................................................................................................................................*..............
0 Description of Soil........................................................................................................................................................................
U ............................................................................................... ---------- ........ ----------%...................................................
....................................................................................................... ---------- -- - -- ---------------------------- ---- -- .....................
—Answer V* —
U Nature of RyeiV or Alterations Wp cable- ------ --- -- ---- -------- ------- -- -- ------ -- ------- --
........ - W .. ..........V 1-.. ...
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Agreement:
The undersigned agrees to in'stall the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been, ued b the b - .health.
S, ed ........ ........ .................... ................... ......... ................................
Y Date
Application Approved By-----------. .... ---- --------- ..---- . Zd.-
Date
Application Disapproved for t e Iffollowing reasons:............ ........................ ..........................................................................
.........................................................................................................................................................................................................
_74Z). Date
PermitNo......................................................... Issued------ ..............I...................
Date
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No ...... 4
THE COMMONWEALTH OF MASSACHUSETTS
-BOARD OF HEALTH
pL _.....OF.............. .......................( �d- _. _............ .
Appliration for Biiptlii al Works Cnnnitrurtinn Prrutit
Application is hereby made for a Permit to Construct. ( ) or Repair ( ) an Individual Sewage Disposal
System at: ;r,
.... .... .. -- -------- -------- ------•--------- --- ----•-- .............----•--
--------- --------- - -----
Loclateioon-Address or Lot No.
W 'dal P'� O r Address
a ---- .................. - -=-------=----•----------------...._._..---....---- -------------------------...._.....--------
Installer Address
UType ",.in Size Lot............................Sq. feet
No. of Bedrooms. _Expansion Attic ( ) Garbage-Grinder ( )
pa-1 Other q"yype of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other
----------------- ----- - -------------------------------- -------------
W Design Flow:____:" ________________________________gallons per person per day. Total daily flow.......__-__._______--.___.__..............gallons.
WSeptic Tank—Liquid capacity............gallons Length---------- ---- Width---------------- Diameter..."............ Depth..............
Disposal Trench—No_.................... Width..............------ Total Length.................... Total leaching area------_____--_______sq. ft.
Seepage Pit No.-------__-_----_- Diameter=------------------- Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by—....................................................................... Date......................................
".
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................
9 -------------------------- .................-••-•••---------•----•--••••--••--•------•---------•--.........................................................
0 Description of Soil..............-.........................................................................................................................................................
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........
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......... .....
U Nature of Re ai or Alterations—An wer en p cable--_ `''�
� -- ------ -- -- ----- 4.. .......
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Agreement: r�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'I T L_ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ued by he b. health
S- ned - •........... ................................
- '
Application Approved By.....-- -----................. ---- .................. ... � _ 1�
r
Date
Application.Disapproved for the following reasons------------------------------•---- - / d
--------------•-----------....-----••-=---•-•------•--------•------------•------••-••---•--=--•---..........•-••--••••-•-------•••-----------•---••--------•••----•--••-••-----------•••-•-•-••___.._..._
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS -
BOARD O"EALTH
................
OF...........-......... .........................-.................... ;
rdifiratr of T>J mptianrr .-
TH I I CE .Ty Y, the Individual Sewage Disposal System constructed ( ) or Repaired ( )
d ',�E✓C 6
by------- . y sta s�. .....................
�L
at - `---: - ,, '" W...-- ----••.-.••____--•------•------
has been installed in accordance with the provisions of ° he State Sanitary Cf' e as d s ibed ' e
application for Disposal Works Construction Permit N +-._---._-!__-_-�_-_-- _- dated-................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.�+--Z/L=---el---------------•------•-------.....---•---- Inspector...........•./ .�__C ....................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
'�+ ✓ .......... ...........OF......... ............................................. "'"�,...�°�'.
No. FEE..._�...............
Mop 1 rk�_P_4
ioat rrntif
•Permission is hereby granted ....------ ..........
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to Const`uct or pair ) an n ividual Sera Di ,��t�tem
�,.,
at No. G
s t .. _
as shown on the application for Disposal Works Construction PprUin No Z0 1 Ltte✓d.----�____________ _ ____________________
^ Board of Health
DATE- f------------------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS